I lost two babies in shattering miscarriages, because I was allergic to gluten

When Janet and Andrew Hewitt started trying for a family, they thought it would happen easily - they were both fit and apparently healthy. So when, after 18 months, Janet still hadn't managed to conceive, they began to wonder if something was wrong and underwent fertility tests.

'But everything came back normal, so we were sent away and told to keep trying,' recalls Janet.

* For more information, visit Coeliac UK at http://www.coeliac.org.uk/ or call 0870 444 8804.

Read more: http://www.dailymail.co.uk/health/article-1174001/I-lost-babies-shattering-miscarriages--I-allergic-gluten.html

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Immune system 'causes miscarriage'

Scientists have moved closer to identifying the malfunction in a mother's immune system that causes some to miscarry..

They now believe that the lack of a single protein may lead to the immune system mistakenly identifying a developing foetus as a foreign invader and targeting it for destruction.

Working with mice, the researchers have identified an immune system protein called Crry which appears to play a crucial role in ensuring that babies are not killed before birth.

This protein is thought to de-activate a part of the mother's immune system to stop it attacking the developing embryo.

Similar proteins are suspected of playing the same role in humans.

A team from Washington University School of Medicine in St Louis, US, has shown that mice bred to lack Crry are unable to give birth to live young.

Instead, their immune system unleashes a destructive attack on the tissues of the developing foetus, which are dismantled and reabsorbed by the mother - the equivalent of a miscarriage in humans.

The researchers discovered that Crry blocks a branch of the mother mouse's body defences called the complement system, which helps destroy foreign material such as infectious organisms.

Crry prevents two other "complement" proteins from marking out cells for immune system destruction.

The researchers studied the cell make-up of foetuses growing in the mice that lacked Crry.

Activated for destruction
They found that by the seventh day of gestation both the outer cells of the embryo and the cells of the developing placenta carried activated complement proteins.

They also found that immune system cells called neutrophils had invaded the complement-targeted tissue.

After 10 days it was clear that the immune system was destroying the embryos.

Dr Molina said: "Without this single molecule, complement components of the mouse immune system are activated, resulting in embryonic death."

The researchers, who reported their findings in the journal Science today, now plan to investigate the role of similar proteins in women's miscarriages.

Two placental proteins perform the same duties as Crry in humans - decay accelerating factor and membrane cofactor protein.

Their role in miscarriages has not been previously addressed.

Dr Molina said: "Using the mouse studies as a framework, we can jump to human studies and see whether miscarriages in women also involve complement regulation."

The work will focus on women who have auto-immune diseases such as lupus erythematosus and multiple miscarriages.

The team will try to determine whether such women have reduced levels of the Crry-like regulatory proteins, and might benefit from receiving them artificially.

Dr Gill Vince, an expert in miscarriage from Liverpool University, said most spontaneous abortions were a one off, but a small group of women suffered repeated miscarriages, around 60% of which were unexplained.

She said: "Any breakthrough in explaining repeated miscarriages is good, but it can be difficult to extrapolate from mice to humans as they have different placental systems."

Related to this story:
- Miscarriage risk of slow eggs (10 Jun 99 Health)
- Genetic miscarriage risk (13 Jan 00 Health)
- Caffeine blamed for miscarriages (25 Nov 99 Health)
- Couples 'need more support after miscarriage' (02 Sep 99 Health)
- Miscarriage prevention therapy 'does not work' (30 Jul 99 Health)
Internet Links:
Science Washington University School of Medicine Miscarriage links

Source: http://news.bbc.co.uk/2/low/health/612021.stm

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The Mysteries of Miscarriage

From too much caffeine to faulty chromosomes, the list of things that can contribute to a lost pregnancy is long. What you need to know about the many risk factors.

Each year, 4 million parents welcome new babies. More than 1 million others lose theirs before they're born. Why? It's the question of the month, after a headline-grabbing study said women who reported consuming more than 200 milligrams of caffeine a day doubled their risk of miscarriage -- from the 12 percent among non-using participants to 25 percent. (A 12-ounce "tall" Starbucks coffee contains 260mg.) Latte lovers flooded doctors' offices with anguished queries. The hysteria is "like an epidemic," says Yale University Ob-Gyn Mary Jane Minkin, author of "The Yale Guide to Women's Reproductive Health."

Caffeine, of course, isn't the only culprit. The list of factors that plays a role in miscarriage is long, and not all of them can be controlled. Or understood. More than half of all miscarriages are caused by chromosomal abnormalities. "It's nature's way of saying, 'this isn't working, so we're going to let it go'," says Duke University Ob-Gyn Susann Clifford. Random chromosomal error causes 70 percent of pregnancies that end before six weeks of gestation, 50 percent of pregnancies that stop between six and 10 weeks and only 5 percent of pregnancies that end after 10 weeks.

Women cannot do much about some risk factors, such as previous miscarriages and advanced maternal age. "You can't change your age, and you can't change your history. It's a frustrating business," says Mount Sinai School of Medicine epidemiologist David Savitz. Older women are simply more likely to conceive embryos with chromosomal abnormalities, such as Down syndrome. In the general population, the risk of miscarriage after six weeks gestation is 15 percent. At age 35, it's 25 percent and at age 40 it's 42 percent.

There are steps that women of all ages can take to lessen other potential risks--even before they conceive. "Good preconception care is probably your best bet," says Dr. Uma Reddy, a medical officer for the National Institute of Child Health and Development. "By the time you come and see your Ob at 11 weeks, it's already too late." Before and after conception, take prenatal vitamins (which include folic acid), don't smoke, avoid second-hand smoke and toxic chemicals, and maintain an ideal body weight. Obesity increases the risk of miscarriage (and birth defects) and is emerging as a significant risk factor for stillbirth, says Reddy. Eating undercooked meat can increase exposure to the bacteria listeria, to E. coli and to the toxoplasma parasite. Cleaning the litter box of an outdoor cat, who may eat an infected bird or rodent, also increases the risk of toxoplasmosis.

Staying calm is important, as well: a British study last year added to the mounting evidence that stress may increase miscarriage risk. (This is the kind of advice that drives already-anxious women crazy, unfortunately.) Avoid alcohol and illicit drugs, such as marijuana, cocaine and heroin. And use acetaminophen (Tylenol) instead of ibuprofen (Advil), which can decrease the amount of amniotic fluid around the baby, says the NICHD's Reddy. To be safe, avoid sushi and limit consumption of fish high in mercury levels, such as canned tuna, says Dr. Diane Ashton, deputy medical director of the March of Dimes. And avoid soft cheeses like brie and gorgonzola, which may contain the bacteria listeria. Limit exposure to chemicals such as home pesticides, mercury and gasoline--but be realistic. "We're not going to recommend that pregnant women never fill their car," says Ashton. Make sure you're vaccinated against chicken pox and rubella (before trying to conceive) since anything that can cause birth defects may also cause miscarriage. And, to repeat the latest news, don't overdo caffeine, which crosses the placental barrier and increases blood pressure and heart rate.

Other potential risk factors require further study. Hot tubs and microwaves ovens, for example, have not received much research attention. Dr. De-Kun Li, the lead author on the caffeine study, has examined them, however, and he tells women to stand at least five feet from a microwave oven, and to stay out of hot tubs since they may raise core body temperature. (In a hot tub, a woman can't sweat to cool off.)

After a woman has miscarried two or more times, doctors may conduct tests of the woman and her partner (or of the miscarriage tissue) to detect chromosomal problems. They may also look for infection of the uterus. And blood tests can detect diabetes, autoimmune disease and hormone imbalance. About one in five women with recurrent miscarriage suffers from a clotting problem that can interfere with implantation; doctors can use blood thinners as treatment.

Many women who've suffered miscarriages think women should ask for a medical workup after a single loss. Darci Klein, founder of PreventPregnancyLoss.org and author of "To Full Term: A Mother's Triumph Over Miscarriage," lost three pregnancies (including a set of twins) before finding out through a blood test that she had a condition that resulted in abnormal clotting. She took a blood thinner--and delivered a healthy son.

"The biggest cause of loss is that women aren't tested after suspicious miscarriage. That leaves women like me to lose pregnancy after pregnancy. Some of them stop trying." She considers factors like caffeine and cat litter "such a small part" of the miscarriage issue. "There may be a few people who cleaned a cat box every year who ended up having problems with their pregnancies," she says. "There are hundreds of thousands of women losing pregnancies to undiagnosed but treatable disorders."

Carrying twins or triplets increases the risk of miscarriage during that pregnancy. So do assisted reproductive technologies, such as in vitro fertilization. With follicle-stimulating drugs called gonadotropins, we may be pushing eggs that are sitting dormant in the ovary to mature," says Dr. Mary Stephenson, director of the recurrent pregnancy loss program at the University of Chicago's Medical Center. "In IVF, we make more than one egg a cycle. Maybe those eggs, we just should have left them alone." Prenatal testing for chromosomal disorders like Down syndrome can also causes miscarriage -- one in 300 procedures for amniocentesis and one in 100 for chorionic villus sampling (CVS).

Fortunately, there's more to avoiding miscarriage than living a life of, well, avoidance. Enjoy exercise and sex, which research shows do not increase the risk of miscarriage. The usual advice for women who've miscarried is to try again. "If you keep trying, the odds are in your favor," says Minkin. Try not to give in to guilt and blame. Sadly, pregnancy loss is incredibly common -- and often mysterious. Says Kaiser Permanente pernatologist David Walton: "Women should consider one miscarriage just a normal event that happens during their reproductive life."

Source: http://www.newsweek.com/id/104816

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Exposure to bisphenol A is associated with recurrent miscarriage

Hum. Reprod. Advance Access originally published online on June 9, 2005
Human Reproduction 2005 20(8):2325-2329; doi:10.1093/humrep/deh888

BACKGROUND: Little is known about the influence of high exposure to bisphenol A on recurrent miscarriage and immunoendocrine abnormalities.

METHODS: Serum bisphenol A, antiphospholipid antibodies (aPLs), antinuclear antibodies (ANAs), natural killer cell (NK) activity, prolactin, progesterone, thyroid-stimulating hormone (TSH) and free T4 were examined in 45 patients with a history of three or more (3–11) consecutive first-trimester miscarriages and 32 healthy women with no history of live birth and infertility. Subsequent pregnancy outcome and embryonic karyotype of abortuses were examined prospectively.

RESULTS: The mean±SD values for bisphenol A in patients were 2.59±5.23ng/ml, significantly higher than the 0.77±0.38ng/ml found for control women (P=0.024). High exposure to bisphenol A was associated with the presence of ANAs but not hypothyroidism, hyperprolactinaemia, luteal phase defects, NK cell activity or aPLs. A high level of bisphenol A in itself did not predict subsequent miscarriage.

CONCLUSION: Exposure to bisphenol A is associated with recurrent miscarriage.

Abstract: http://humrep.oxfordjournals.org/cgi/content/abstract/20/8/2325?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Feb.+28+issue&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

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Losing a baby

Why miscarriages occur, and what can we do to minimise its occurrence.

AS an obstetrician, my job is to help pregnant mothers welcome their babies into this world. Therefore, I have always found that the hardest part of the job is when the pregnancy ends in a miscarriage, and my patients turn to me and ask, “Why did this happen?”

If dealing with miscarriage is difficult for me, I can’t imagine how heartbreaking it must be for the women who have this precious gift snatched right out of their hands.

In this article, I will talk about how to recognise when you’re having a miscarriage and reducing your risk factors for miscarriage.

Defining a miscarriage

A miscarriage is the loss of a baby before the 20th week of pregnancy, with most miscarriages occurring in the first trimester.

Up to 15% of all recognised pregnancies end in miscarriage – however, many more miscarriages actually occur, but women are not aware of them because they did not know that they were pregnant in the first place.

The most obvious signs of a miscarriage are vaginal bleeding or spotting, pain or cramping of the abdomen, passing of tissue from the vagina and fluids draining out from the vagina.

If you are pregnant and experience any of these signs, go to your obstetrician immediately.

When a miscarriage occurs, the first instinct is to ask, “Why did this happen? What did I do wrong?” Relatives or friends may make things worse by telling you that you should not have eaten this or done that during your pregnancy.

Some old wives’ tales may blame a miscarriage on “bad” foods, sex, too much exercise, bad feng shui or even astrological signs! However, these are unfounded beliefs. Even we doctors do not really know the cause of most miscarriages.

We do know that they are often caused by chromosomal abnormalities in the unborn baby, but we do not know what specifically causes these abnormalities.

The result is that the baby cannot develop normally, and the body spontaneously terminates the pregnancy.

There are some things that have been identified as definite risk factors for miscarriage.

Although there are no guarantees against a miscarriage, you can try to change your lifestyle or seek medical advice to reduce as many of these risk factors as possible.

Here are three things that you should definitely do during pregnancy to prevent a miscarriage: don’t smoke, don’t use illegal drugs and don’t drink too much alcohol.

You may have certain medical problems, hormonal disorders or chronic diseases that can affect your pregnancy – talk to your obstetrician before you get pregnant about your options for medical or surgical treatment to treat these conditions.

Certain infections during pregnancy, such as rubella, can also cause miscarriage, which is why it is very important that you be tested for these infections and take precautions to avoid being infected while you are pregnant.

Finally, getting pregnant at an older age, and above, puts you at higher risk of having a miscarriage.

However, I wish to stress again that these are only risk factors; just because you are an older mother-to-be does not mean you will definitely miscarry.

What if I have repeated miscarriages?

Some women have several subsequent miscarriages, which can be very distressing for them and their families.

I comfort my patients by telling them that 85% of women who miscarry go on to have a healthy next pregnancy.

Unfortunately, there are some women who have repeated miscarriages, due to medical problems that have not been treated.

For instance, if the repeated miscarriages are caused by cervical incompetence, you can undergo a procedure to keep the cervix closed throughout the pregnancy.

If you have a chronic disease like diabetes, you have to keep the condition under control (such as by maintaining healthy glucose levels) to reduce the chances of another miscarriage.

If you have several miscarriages, your doctor should conduct a complete medical check to try and determine the cause.

Often, however, your doctor will not have an answer. Do not blame him or her, as miscarriages still remain a mystery in medical science.

It may be Mother Nature’s way of ensuring that your pregnancy will not go on to harm you or your unborn baby.

This is not a time for anger and recrimination between you and your partner. You will both need time to grieve and to come to terms with the fact.

Cast out thoughts such as, “I should not have eaten that food”, “I should not have done that exercise” or even “I should not have had sex during pregnancy”.

Blaming yourself or each other will only make the pain worse.

In my next article, I will talk about the emotional impact of a miscarriage, and how women and men can cope with it.

- Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). She is co chairman of Nur Sejahtera, Women & Family Healthcare Program, Ministry of Women, Family and Development.

Source: http://thestar.com.my/health/story.asp?file=/2008/1/13/health/19984767&sec=health

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Miscarriage: Why It Happens and How Best to Reduce Your Risks

I just noticed that you can find book reviews online with Google, so I thought I would share a few books I found on miscarriage and loss. Have you read this one? What did you think of it?

Miscarriage: Why It Happens and How Best to Reduce Your Risks
by Henry Lerner

Published 2003, 256 pages, ISBN 0738206342

- Whether it happens in the first trimester or later on in pregnancy, a miscarriage is an emotionally traumatic event. It may also be a physically daunting experience, resulting in the need for surgical intervention.

In the aftermath of a miscarriage there are almost always unanswered questions: Why did it happen? Did I do anything to cause my miscarriage? Will I have a miscarriage the next time I get pregnant? Most important of all,

You will want to know, "What can I do to best prevent miscarrying again?" This compassionate and authoritative guide fills the information void. From the causes of miscarriage -- chromosomal, illness-related, immunologic -- to the diagnostic tests and surgical procedures now available to help prevent you from miscarrying again, Dr. Henry Lerner has compiled the most current medical information on why miscarriages do and don't happen, and explains the best methods for recovering and preparing to conceive again.

He also includes reassuring and practical advice from an expert in women's reproductive psychology on coping with the disappointment and depression that often accompany the loss of your pregnancy, and the anxiety that may come with your next positive pregnancy test.

Book Reviews, Previews & more: http://books.google.com/books?id=uLlldF7YKKwC

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Embryo Toxic Factor (ETF)

Some of the common causes of miscarriage are due to pregnancy complications such as blighted ovum, ectopic pregnancy or molar pregnancy. However, women who experience multiple miscarriages will likely require further assessment in order to determine whether or not an underlying condition may be affecting fertility. Among the various fertility testing procedures that may be performed is the embryo toxic factor (ETF) test.

What is Embryo Toxic Factor?
Embryo toxic factor is a cytokine that is secreted by the immune system’s white blood cells in response to pregnancy tissue. If excess amounts of ETF are produced by white blood cells during pregnancy, the immune system may recognize the embryo as a foreign substance and may attack the embryo in order to maintain the body’s health. This in turn will lead to a miscarriage.

Diagnosing Embryo Toxic Factor
Diagnosing embryo toxic factor requires a complicated procedure involving laboratory analysis. For this reason, unless a woman suffers from recurrent miscarriages and requires testing for infertility, this type of diagnostic procedure will not be performed. In fact ETF testing is not a routine procedure, and is considered an experimental testing method.
ETF testing involves two stages to determine whether or not the body is producing an immune system response to pregnancy. The test aims to assess whether or not the body’s lymphocytes (white blood cells) are producing any type of substance that would be harmful to a developing embryo.

A blood sample will first be taken in order to isolate certain lymphocytes. These lymphocytes will be treated with a solution and left to culture for several days. These lymphocytes will then be combined with cultured mouse embryos and allowed to sit for several days. A fertility specialist will then assess the embryo development as it is affected by these lymphocytes. If the embryos have stopped developing or have died, the presence of ETF will be determined. If the embryos are developing normally, no ETF is secreted.

ETF Treatment and Miscarriage Prevention
In order to prevent the recurrence of miscarriage, certain treatment options are available for women with embryo toxic factor. Treatment of ETF to avoid further pregnancy complications typically involves immune system suppression in order to allow embryo development and implantation to occur.

Treatment may involve the following:
• progesterone in vaginal suppositories or gel caps taken until the sixteenth week of pregnancy
• IVIg infusions from donor blood
• progesterone oil injections in cases when the women is undergoing IVF treatment

Progesterone is commonly used to increase hormone levels and strengthen the uterus, and in higher doses works to suppress the immune system. Dosage is typically 200mg to 400mg, and is taken twice daily. Speak to your health care provider for more information regarding your particular health concerns.

Source: http://www.womens-health.co.uk/miscarriage_embryo.html

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'My joy at finally becoming a mother after losing eight babies'

After eight miscarriages, Sarah Whitman feared she would never become a mother.

She and her husband Martin had endured 15 years of heartbreak as she became pregnant again and again, only to miscarry.

Even with extensive drug treatments, they were unable to achieve their dream.

But then somehow their luck changed and Maya was born - a 7lb 1oz bundle of perfect, healthy baby.

Mrs Whitman, 37, said: "I can't believe we finally have our beautiful daughter with us at last, after losing our eight previous babies.

"It just seemed like after 15 years we would never be parents - so to have our daughter now after all this heartbreak is really a miracle."

The couple, who live in Banbury, Oxfordshire, began trying for a family in 1991, two years after they were married.

The following year Mrs Whitman became pregnant but miscarried at 12 weeks. She said: "I just accepted that it was one of those things, and concentrated on getting pregnant again."

In June 1993, she became pregnant again, but at ten weeks suffered her second miscarriage.

Mrs Whitman, a full-time mother who lives with Martin, 37, a factory worker, then lost a third baby.

Afterwards, she went to see her GP and blood tests were carried out to see if there was a medical reason why she had had the miscarriages - Mrs Whitman said: "They couldn't find anything wrong, so we just assumed that we were unlucky.

"But two years later, in June 1996, I suffered my fourth miscarriage. I knew by now that something must be wrong."

Mrs Whitman was referred to St Mary's Hospital in London, which has a specialist miscarriage centre.

She was diagnosed with antiphospholipid syndrome, where the body's immune system thinks that the foetus is a foreign body and tries to expel it. Blood clots build up in the placenta and cause a miscarriage.

Doctors told her that when she conceived again, they would give her medication to thin the blood in her placenta.

Mrs Whitman said: "I was so relieved that I finally had an answer to why I was losing my babies like this. I was confident that the next time I fell pregnant, then this time I would finally become a mum."

Despite the medication, however, over the next few years the couple lost another four babies.

Eventually they discussed adoption, but while on holiday in May 2006 decided to have one last try.

Mrs Whitman said: "We came home and I felt different. I knew I was pregnant, but this time instinctively everything just felt right."

The pregnancy went smoothly until the 22nd week, when complications threatened to bring on an early labour. To prevent this, she had to stop her medication - at the risk of starving the baby of nutrients.

Doctors at Horton General Hospital in Banbury carried out a caesarean to deliver Maya at 38 weeks, in January this year.

Mrs Whitman said: "It was so emotional when she was born. We had waited 15 long years."

Maya is now eleven months old and in perfect health, said her mother, adding: "One day we will tell her how special she is."

Source: http://www.dailymail.co.uk/pages/live/femail/article.html?in_article_id=504524&in_page_id=1879&ICO=FEMAIL&ICL=TOPART

CellCept Gets New FDA Warning on Miscarriage, Birth Defects

CellCept, a drug used to prevent organ rejection after a transplant, has been linked to an increased risk of miscarriage and birth defects. The new findings have prompted the Food & Drug Administration (FDA) to add a new boxed warning to the CellCept label, and Roche Holding AG, the drug’s maker, has sent a letter to physicians informing them of the CellCept risk and labeling changes. The potential for these drug side effects are so great that the FDA is advising women of childbearing age to use two methods of birth control before, during and after their treatment with CellCept.

CellCept, also known by its generic name mycophenolate mofetil, is part of a class of drugs called immunosuppressants. It was approved in 1995 to prevent rejection of solid organ transplants, including kidney, heart and liver. When used in combination with cyclosporine and corticosteroids, CellCept can greatly reduce the chance that a patient’s immune system will attack a transplanted organ. However, like all immunosuppressant drugs, CellCept does carry certain risks, including the development of lymphoma and other malignancies. Like other drugs in its class, CellCept is also linked to an increased risk of developing opportunistic infections and sepsis.

A recent analysis of data regarding CellCept from the National Transplantation Pregnancy Registry has led the FDA to conclude that pregnant women taking CellCept have a significantly higher risk of miscarriage during the first trimester, and that their babies are more likely to develop birth defects, including external ear and facial abnormalities such as cleft palate and lip, and problems with the distal limbs, esophagus and kidney. While it was known previously that CellCept could cause problems during pregnancy, the FDA had classified the risk as Category C (Risk of Fetal Harm Cannot be Ruled Out). These side effects are now classified as Category D (Positive Evidence of Fetal Risk).

The FDA is now warning that doctors should tell female patients of childbearing age about CellCept miscarriage and birth defect risks. Women of childbearing age who receive CellCept must be counseled on contraceptive use, and they should be made aware that the drug can interfere with the effectiveness of oral contraceptives.

The FDA is also now requiring women of childbearing age to undergo pregnancy testing within one week of beginning CellCept therapy. A female patient prescribed CellCept should begin using contraceptives four weeks prior of starting the drug, and for six weeks after stopping. The FDA is also advising that female patients of child bearing age use two methods of birth control while taking CellCept. Finally, the FDA is advising that a woman planning a pregnancy should not be prescribed CellCept unless no other immunosuppressant drugs have been successful in avoiding organ rejection.

Finally, to further monitor fetal outcomes of pregnant women exposed to CellCept, a National Transplantation Pregnancy Registry has been established. The FDA is encouraging doctors to register their female CellCept patients by calling 1-877-955-6877.

Source: http://www.newsinferno.com/archives/1971

A loss that is hard to bear

As soon as a pregnancy is detected, each prospective parent looks forward to and plans for their new arrival. If the pregnancy is lost this is often considered a death within the family. The loss of a pregnancy can be devastating for a couple regardless of the number of children in the family or the cause for the loss. Many couples blame themselves for their pregnancy loss. It is very rare that either member of the couple has done anything that would result in a pregnancy loss.

Recurrent pregnancy loss (RPL) (recurrent abortion; habitual abortion) is typically defined as three or more consecutive pregnancy losses that occur usually before 20 weeks of gestation.

Although approximately 25 per cent of all pregnancies result in miscarriage, less than five per cent will experience two consecutive miscarriages, and only one per cent will experience three or more.

Causes

The causes for RPL could be divided into two major categories namely, foetal and maternal.

Foetal causes: These include the genetic composition of the foetus. It is uncommon to find an inherited genetic cause for recurrent miscarriages. A chromosome analysis performed from the parents' blood identifies an inherited genetic cause in less than five per cent of couples.

In contrast to this, many early miscarriages are due to the denovo (by chance) occurrence of a chromosomal abnormality in the embryo. About 60 per cent or more of early miscarriages may be caused by a random chromosomal abnormality, usually a missing or duplicated chromosome.

Maternal causes: These include abnormalities in the environment in which the foetus develops. The chance of miscarriages increases as a woman ages.

After the age of 40 years, more than one-third of all pregnancies end in miscarriage. Most of the embryos have an abnormal number of chromosomes.

Distortion of the uterine cavity is considered to cause about 10 to 15 per cent of recurrent miscarriages. The most common abnormality is a uterine septum i.e., a partition of the uterine cavity. The diagnosis can be made by x-rays or ultrasound scan of the uterus.

The other congenital abnormalities include a double uterus, and a uterus in which only one side has formed. Scar tissue in the uterine cavity, large uterine fibroids and polyps could result in pregnancy loss. In the second trimester, a weak cervix can become a recurrent problem. Most of these conditions can be surgically treated.

Immunological Causes: Two major categories of immunologic causes of RPL are autoimmune, in which the woman's immune system attacks her own organs and tissues, and alloimmune, in which the immune system attacks tissues considered foreign.

Autoimmune disease or dysfunction may play a role in up to 10 per cent of RPL. Phospholipids are molecular building blocks that form a large portion of the walls of cells in the body, which includes placental cells.

Antiphospholipid syndrome (APS) is an autoimmune dysfunction where antibodies are produced against phospholipids that form part of the blood vessel walls.

Hence clots are produced in the placental blood vessels blocking off the blood supply to the foetus thus producing foetal demise.

Without treatment, couples with APS have a poor chance of carrying a foetus to term. Low dose aspirin and low molecular weight heparins definitely help in this sub-group of patients.

Allo immune dysfunction

Normally a person will reject dissimilar (non-self) tissues or structures from the body using the immune system.

In pregnancy, the placenta and growing embryo are not entirely self, but rather are a result of both the maternal and paternal genetic heritages. The placenta has a privileged relationship with the pregnant woman that allows for it to escape rejection. When this mechanism is disturbed, it can result in foetal loss.

Miscellaneous : Causes related to an action of the mother are very uncommon but can include exposure to chemical toxins, X-rays in early pregnancy and rarely heavy smoking and alcohol abuse. Medications taken during pregnancy should be reviewed with an obstetrician.

Treatment: The two main treatment options are as follows: Leucocyte immunisation with paternal or donor blood cells, or immunoglobulin treatment with IV injections, which is very expensive. This should be conducted only in research settings, as their benefits are largely unproven.

Poorly controlled diabetes increases the rate of miscarriage.

Women with diabetes improve pregnancy outcome if blood sugars are controlled before conception. Women who have insulin resistance, such as obese women and women with polycystic ovaries also have higher rates of miscarriages.

The second half of the menstrual cycle, that is the time from ovulation up to the next period, is called the luteal phase. This phase is characterised by high circulating levels of a hormone called progesterone in the blood.

Progesterone, which is produced by the ovary after release of an egg (ovulation), is necessary for a healthy pregnancy.

Inadequate levels of progesterone, often called as luteal phase deficiency may cause repeated miscarriages. This concept is still under controversy and needs more evidence to prove the absolute necessity of progesterone for the development of a strong pregnancy. If an inadequate progesterone effect is documented or believed to exist during the luteal phase of the menstrual cycle, then either supplemental progesterone (either as oral tabs, vaginal pessaries, vaginal gel or injections), or supplemental HCG (human chorionic gonadotrophins) as injections every few days following ovulation to enhance the ovary's own progesterone productions are treatment options.

Source: http://www.newindpress.com/NewsItems.asp?ID=IE320070828042934&Page=3&Headline=A+loss+that+is+hard+to+bear&Title=Features+-+Health+%26+Science&Topic=168

Lower your miscarriage risk with new tests, treatments

When Kori Morrison had her first miscarriage, she and her husband, Tom, were upset but still hopeful. After all, she knew that 15 to 50 percent of all pregnancies end in miscarriage, and most of these women who've miscarried go on to have healthy babies. But in the next eight years, Morrison had four more miscarriages. Sadness and self-blame set in. "I wondered if I was eating the wrong things, if I was overstressed, or, worst of all, if my body just wasn't cut out for pregnancy," she says.

Morrison was eventually found to have a hormone imbalance: Low progesterone during pregnancy kept her uterus from nourishing the embryo. With treatment, she went on to have four children.

Although Morrison went through agony for years before discovering what was wrong, her story illustrates that there are ways to identify what causes miscarriages and what can be done to prevent them. Important to know because, while most women will go on to have a successful pregnancy, about 5 percent are likely to lose another baby. And the use of assisted reproductive technology such as in vitro fertilization (common among women 35-plus) seems to boost miscarriage risks even more.

1. Do a little detective work

When you're planning to get pregnant, your first move should be a careful prepregnancy checkup to reveal potential risk factors like diabetes-related problems, high blood pressure, polycstic ovary syndrome, fibroids, or thyroid abnormalities -- all of which are mostly treatable, says Mary Stephenson, M.D., professor of obstetrics and gynecology and director of the recurrent-pregnancy-loss program at the University of Chicago Medical Center.

Go over your medical history with your doctor, and also mention any medications, herbs, and supplements you are taking. You might learn something about potentially risky non-prescription meds such as ibuprofen or herbs such as ginkgo. Even taking a little time to discuss a family history of miscarriages with your doctor might uncover a correctable problem.

Full article: http://edition.cnn.com/2007/HEALTH/conditions/08/17/healthmag.baby.maybe/

An informative protocol for the investigation of recurrent miscarriage: preliminary experience of 500 consecutive cases

A total of 500 consecutive women (mean age 32.9 years; SD 5 years) presenting with a history of recurrent miscarriages (median 4; range 3–17) were investigated for the presence of antiphospholipid antibodies (APA), polycystic ovaries (PCO), hypersecretion of luteinizing hormone (LH) and chromosome abnormalities in order to detect an underlying cause of their pregnancy losses.

All women had details of their previous reproductive history, investigations and treatment documented: 76% of the women had experienced only early pregnancy losses (miscarriage less than 13 weeks gestation); 32% had a history of subfertility; and significant parental chromosome rearrangements were present in 3.6% of couples. An ultrasound diagnosis of PCO was made in 56% of women, 58% of whom were demonstrated to hypersecrete LH, based on early morning urinary LH analysis.

Circulating APA were found in 14% of women. An underlying cause of recurrent miscarriage — genetic, endocrine or autoimmune — was found in less than 50% of couples. Women in the latter two groups are being recruited to randomized treatment trials which are discussed.

Source: http://humrep.oxfordjournals.org/cgi/content/abstract/9/7/1328

Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (

Objective: To determine whether treatment with low dose aspirin and heparin leads to a higher rate of live births than that achieved with low dose aspirin alone in women with a history of recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies), lupus anticoagulant, and cardiolipin antibodies (or anticardiolipin antibodies).

Design: Randomised controlled trial.

Setting: Specialist clinic for recurrent miscarriages.

Subjects: 90 women (median age 33 (range 22-43)) with a history of recurrent miscarriage (median number 4 (range 3-15)) and persistently positive results for phospholipid antibodies.

Intervention: Either low dose aspirin (75 mg daily) or low dose aspirin and 5000 U of unfractionated heparin subcutaneously 12 hourly. All women started treatment with low dose aspirin when they had a positive urine pregnancy test. Women were randomly allocated an intervention when fetal heart activity was seen on ultrasonography. Treatment was stopped at the time of miscarriage or at 34 weeks' gestation.

Main outcome measures: Rate of live births with the two treatments.

Results: There was no significant difference in the two groups in age or the number and gestation of previous miscarriages. The rate of live births with low dose aspirin and heparin was 71% (32/45 pregnancies) and 42% (19/45 pregnancies) with low dose aspirin alone (odds ratio 3.37 (95% confidence interval 1.40 to 8.10)).

More than 90% of miscarriages occurred in the first trimester. There was no difference in outcome between the two treatments in pregnancies that advanced beyond 13 weeks' gestation. Twelve of the 51 successful pregnancies (24%) were delivered before 37 weeks' gestation. Women randomly allocated aspirin and heparin had a median decrease in lumbar spine bone density of 5.4% (range -8.6% to 1.7%).

Conclusion: Treatment with aspirin and heparin leads to a significantly higher rate of live births in women with a history of recurrent miscarriage associated with phospholipid antibodies than that achieved with aspirin alone.
Full article: http://www.bmj.com/cgi/content/abstract/314/7076/253

Solving the mystery of recurrent miscarriage

A world-class unit that helps the childless is under threat, Victoria Lambert finds

Last Updated: 12:01am BST 04/06/2007

A world-class unit that helps the childless is under threat, Victoria Lambert finds

'Few seem to understand how low it can bring you," says Katrin Roskelly, her voice tight with emotion at the memory of her three recent miscarriages.

"I was heartbroken. You're expected to dust yourself down and just keep trying, yet instinct told me I needed a period of mourning.

"One nurse, when she learnt my age, told me I couldn't hang about and said I had to 'get back on the bike'. I found it devastating. I'm a person, not a breeding machine."

Katrin, a 42-year-old financial PR from Notting Hill, married Michael, 45, who works in property, late in life.

Their marriage, two years ago, was a joyous event, and they were keen to try for a child - although sanguine about their chances. "Time was not on our side, and we had no expectations."

So when Katrin quickly became pregnant they were thrilled. "I knew how difficult many women found conception, so it seemed an incredible bonus that I could do it so easily."

But Katrin was "shattered" when she miscarried at eight weeks.

Six months later, she miscarried again; another six months passed and, having become pregnant with twins, Katrin was horrified to learn that there was no sign of either heartbeat on the scanner - they had not made it.

Instead, she had to undergo an ERPC (evacuation of retained products of conception), a traumatic procedure to clear the womb of the foetal remains.

She had lost four babies in 18 months.

Sadly, Katrin's heartache is far from unique. One in seven couples is affected by infertility, one in every four pregnancies ends in miscarriage, and between one and two per cent of women suffer recurrent miscarriages (classified as three or more consecutive losses), as she did.

In desperation, Michael and Katrin paid for private tests to see if there was anything broken that science could fix, but all came back negative. It was their lowest moment. Finally, they were referred to Professor Lesley Regan, head of obstetrics and gynaecology at St Mary's Hospital, west London: "That's when our luck changed," says Katrin.

The hospital's Recurrent Miscarriage Clinic (RMC), opened in 1990, is the largest of its kind in the world.

It deals with more than 1,000 new referrals each year and has an astonishing 80 per cent success rate, delivering, on average, three healthy babies every day.

It's a tribute to its dedicated, multi-disciplinary team, but also to years of pioneering research.

No wonder their regime, based around regular testing for abnormal hormone levels, sub-fertility, genetic conditions and clotting disorders, and the use of drugs such as heparin and aspirin, combined where necessary with surgical procedures such as cervical stitches, has been imitated worldwide.

Most crucially, the team pioneered the correct diagnosis and treatment of Antiphospholipid Syndrome.

Antiphospholipid antibodies in the blood make the immune system work too hard, increasing clotting. This affects the placenta, where small clots form that may prevent its implantation or prevent it from getting vital nutrients to the foetus.

Sufferers have only a 10 per cent chance of their pregnancy surviving to full term. The clinic has established that up to 20 per cent of all women who have had recurrent miscarriages have the condition. It can be difficult to diagnose, but is comparatively easy to treat with blood-thinning drugs.

Since the clinic is on one site, the team enjoys a constant flow of ideas from the labs to the bedside.

"An observation made by a patient leads us to posing a question and then designing an experiment to try to answer it," says Prof Regan.

Yet this great British success story is under threat. Last year, a health and safety inspectorate declared one of the RMC's two laboratories, which are housed in Victorian stables, unfit for purpose and the other in need of an overhaul - something the hospital cannot afford.

"For patients with repeated miscarriages, every month counts as their fertility declines," explains Prof Regan.

"We don't have time for endless consultations; rebuilding the unit quickly means the difference between giving our patients the promise of a baby or condemning them to childlessness for ever."

But the unit's 30-odd members of staff refuse to give up: earlier this year, they launched the Save the Baby Unit Appeal to raise the desperately needed £1 million, and with the help of hospital executives, patients and friends of the hospital, £450,000 has been pledged.

For Katrin, her appointment with Prof Regan was a turning point.

"She carried out more tests, then confidently told me to go away and get pregnant. Incredibly, I conceived that month, and with Prof Regan's work, advice, encouragement, regular scans, and a feeling of positivity that I can't begin to explain, my pregnancy developed normally."

Katrin went to "masses of yoga classes, took naps, found a brilliant antenatal counsellor, and ate like a horse".

Her recurrent miscarriages remain unexplained, but Prof Regan's inspiring care undoubtedly helped her through.

A previous operation for fibroids meant that she had to book in for a Caesarean on April 19. It was quick and remarkably pain free. And then came that heart-stopping moment when midwife turned to the new mother and said: "Would you like to meet your baby daughter?" Alexandra Constance Roskelly - 8lb 2oz - had arrived safely. "It was overwhelming," says Katrin.

"She's beautiful, extraordinary. She is a miracle."

The Save the Baby Unit Appeal is holding a Literary Auction on June 12 in Mayfair, hosted by Alan Coren. For information and tickets to this event or the Appeal's charity ball, email marystanton2412@aol.com ; or see www.savethebabyunit.org

Source: http://www.telegraph.co.uk/health/main.jhtml?xml=/health/2007/06/04/hmisc104.xml

Immunology may be key to pregnancy loss

Until the last decade, there was little a couple could do if they suffered from recurrent pregnancy losses. Miscarriages that couldn't be attributed to chromosomal defects, hormonal problems or abnormalities of the uterus were labeled "unexplained," and couples would continue to get pregnant, only to suffer time and again as they lost their babies. New research, however, has provided information on the causes of the heretofore unexplained pregnancy losses allowing more effective treatment enabling women to carry their babies to term.

About 15 to 20 percent of all pregnancies result in miscarriage, and the risk of pregnancy loss increases with each successive pregnancy loss. For example, in a first pregnancy the risk of miscarriage is 11 to 13 percent. In a pregnancy immediately following that loss, the risk of miscarriage is 13 to 17 percent. But the risk to a third pregnancy after two successive losses nearly triples to 38 percent.

Many doctors do not begin testing for the cause of pregnancy loss until after three successive miscarriages. However, because the risk of loss to a third pregnancy after two successive miscarriages is so high, the American College of Obstetrics and Gynecologists (ACOG) now recommends testing after a second loss - especially for women over the age of 35.

There are two major reasons for recurrent spontaneous abortion (RSA), or miscarriage. One is that there is something wrong with the pregnancy itself, such as a chromosomal abnormality that curtails embryonic development. (A fertilized ovum is an embryo until 10 weeks gestation, and a fetus thereafter. Most miscarriages, though not all, occur between six and eight weeks, with expulsion taking place four weeks later, between 10 and 12 weeks.)

Full article: http://www.inciid.org/article.php?cat=miscarriage&id=374